text: Opioid drugs are known to cause opioid-induced constipation (OIC) by inhibiting gastric emptying and decreasing peristaltic waves leading to delayed absorption of medications and more water absorption from the feces. That can result in hard and dry stool and constipation for some patients.
  OIC is one of the most common adverse effects caused by opioids, so the discovery of PAMORAs can prevent the effects that often compromise pain management.
  Methylnaltrexone bromide was the first medication in the drug class approved by the FDA. It was discovered in 1979 by Leon Goldberg, a pharmacologist at the University of Chicago. Having witnessed the suffering of a dying friend with OIC, Goldberg tested various derivatives of naltrexone, a drug known to block the effects of opioids. His objective was to find a drug that could not pass the blood brain barrier, without affecting the analgesic effects of the opioids. After Goldberg died, his colleagues at the university continued to develop the compound. It was approved by the FDA in April 2008, originally for OIC in adult patients with advanced illness and later in adult patients with chronic noncancer pain.
  In the late 1970s, Dennis M. Zimmerman and his co-workers from Lilly Research Laboratories, Indiana, did research on structural concepts for narcotic antagonists defined in a 4-phenylpiperidine series. They reported N-methyl-trans-3,4-dimethyl-4-phenylpiperidine to be pure opioid receptor antagonist with a new pharmacophore. To increase the potency they attached a phenolic group to the aromatic ring, N-methyl-trans-3,4-dimethyl-4-(3-hydroxyphenyl)piperidine. That structure was used to design and develop other opioid receptors antagonists such as alvimopan. Alvimopan was approved later in 2008 for in-hospital use to increase the gastrointestinal function following a partial large or small bowel resection with primary anastomosis. Naloxegol was approved in September 2014 and naldemedine in March 2017, both for the treatment of OIC in adult patients with chronic cancer.